基于共识的眼动脉段动脉瘤治疗后的视觉后遗症：约翰霍普金斯大学的经验。

Visual sequelae after consensus-based treatment of ophthalmic artery segment aneurysms: the Johns Hopkins experience.

机构信息

Department of Ophthalmology, The Johns Hopkins Hospital, Baltimore, MD, USA.

出版信息

J Neuroophthalmol. 2012 Mar;32(1):27-32. doi: 10.1097/WNO.0b013e31823b6c60.

DOI:10.1097/WNO.0b013e31823b6c60

PMID:22146516

Abstract

BACKGROUND

To determine the anatomic and visual outcomes of patients with ophthalmic artery segment aneurysms treated at The Johns Hopkins Hospital using a consensus-based treatment algorithm.

METHODS

Retrospective record review of a prospectively accrued case series of 88 patients (101 aneurysms) treated between January 2004 and July 2009. Presenting symptoms and aneurysm parameters were recorded for all subjects. Treatment strategy for all patients was determined by consensus among neurosurgeons, neurointerventionalists, neurologists, and neuroophthalmologists meeting to review the clinical cases on a weekly basis. Final clinical outcomes (aneurysm control, functional status, and vision) were ascertained from in-house examinations, medical records, telephone interviews, or a combination of these methods. Risk factors for visual or other complications were evaluated.

RESULTS

An optic neuropathy was present in at least 30 (34%) of 88 patients after treatment. Presumed new visual loss occurred in 24 (27%) of these patients. The remaining 6 patients had preexisting optic neuropathy-related visual loss that worsened after treatment. No patient with a preexisting optic neuropathy improved following treatment.

CONCLUSION

Ophthalmic artery segment aneurysms present a treatment challenge because of their anatomic complexity and relationship to critical neural structures, particularly the visual sensory pathway. We have adopted a consensus-based treatment approach in an effort to optimize patient outcomes and aneurysm control. Although our approach resulted in durable treatment of the aneurysm, a sizable proportion of patients experienced new vision loss after treatment, and no patient with preexisting visual loss related to their aneurysm experienced visual improvement after treatment. We recommend that all patients with ophthalmic artery aneurysms receive careful and thorough preprocedural counseling to ensure they are aware of the risks and benefits of treatment regardless of the method used.

摘要

背景

为了确定使用基于共识的治疗方案在约翰霍普金斯医院治疗的眼动脉段动脉瘤患者的解剖和视觉结果。

方法

回顾性记录 2004 年 1 月至 2009 年 7 月期间连续收治的 88 例（101 个动脉瘤）患者的前瞻性病例系列研究。记录所有患者的首发症状和动脉瘤参数。所有患者的治疗策略均由神经外科医生、神经介入医生、神经科医生和神经眼科医生通过每周一次的临床病例会议进行共识确定。最终的临床结果（动脉瘤控制、功能状态和视力）通过内部检查、病历、电话访谈或这些方法的组合来确定。评估了视觉或其他并发症的危险因素。

结果

治疗后至少 30 例（34%）88 例患者存在视神经病变。这些患者中有 24 例（27%）出现了推定的新视力丧失。其余 6 例患者在治疗后视力丧失加重，其视神经病变相关的视力丧失已经存在。治疗后没有患者的视神经病变得到改善。

结论

眼动脉段动脉瘤由于其解剖结构复杂且与关键神经结构（特别是视觉感觉通路）关系密切，因此治疗具有挑战性。我们采用了基于共识的治疗方法，以努力优化患者的结局和动脉瘤的控制。尽管我们的方法导致了动脉瘤的持久治疗，但相当一部分患者在治疗后出现新的视力丧失，而没有任何患者的视神经病变与治疗后视力改善相关。我们建议所有眼动脉动脉瘤患者在接受治疗前都要接受仔细和全面的咨询，以确保他们了解治疗的风险和益处，无论使用何种方法。